Faculty Collaboration Database

Low profile vascular plugs for paravalvular leaks after TAVR. Catheter Cardiovasc Interv 2014 Feb;83(2):280-8

Date

09/17/2013

Pubmed ID

24038981

DOI

10.1002/ccd.25202

Scopus ID

2-s2.0-84892786406 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

BACKGROUND: Paravalvular leak (PVL) after transcatheter aortic valve replacement (TAVR) is associated with less good outcomes. The use of percutaneous plugs is among the strategies to treat PVL after TAVR. Plugs have been limited by the need to pass 4-6 F delivery sheaths between the TAVR stent frame and the native valve leaflets.

METHODS: The study population consists of six patients who had at least moderate aortic insufficiency (AI), and also developed symptoms of heart failure after TAVR. We describe in detail the use of low profile vascular plugs that require crossing the leaks with only a 4 F diagnostic catheter.

RESULTS: Low profile vascular plugs were successfully deployed in all six patients without significant complications. Fluoroscopy time ranged 16.7-69.4 min (44.8 ± 18.8 min). Contrast volume ranged 15-100 mL (45 ± 34 mL). One plug was used in five, and two adjacent plus in one case. AI severity was reduced from moderate or severe to mild or less in four patients, from severe to moderate in one, and in one, there was no change. Five of six patients were treated electively and were significantly improved in terms of both echocardiographic PVL and also symptoms. The one who did not have echocardiographic improvement did not improve clinically and expired one month later.

CONCLUSIONS: PVL closure can be consistently accomplished after TAVR with low profile vascular plugs. Careful analysis of PVL location on echo before closure greatly facilitates finding the fluoroscopic location of the leak. Decreases in PVL severity are associated with significant clinical improvement.

Author List

Feldman T, Salinger MH, Levisay JP, Smart S

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve Insufficiency
Cardiac Catheterization
Cardiac Catheters
Contrast Media
Equipment Design
Female
Fluoroscopy
Heart Failure
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
Humans
Male
Prosthesis Design
Radiography, Interventional
Severity of Illness Index
Treatment Outcome
Ventricular Dysfunction, Left